Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Understanding, Optimizing and Implementing Workflow with IHE John Paganini IDX Systems Charles Parisot GE Medical Systems-IT

2. Learning Objectives • Understand how the IHE Scheduled Workflow Integration Profile streamlines radiology data workflow • Learn how to practically apply IHE in solving some of the typical workflow cases

3. Discussion Areas • Workflow Defined • What Are The Benefits? • How Do I Get It? • What Systems Should Be Considered For Integration? • What Is The Sequence To Follow?

4. “Enter the data one time and then pass it from system to system.” On Brookwood Medical Center, Birmngham, AL

5. Scheduled Workflow Charge Posting Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow Patient Information Reconciliation Consistent Presentation of Images Simple Image and Numeric Reports Evidence Documents Key Image Notes Access to Radiology Information Basic Security IHE Integration Profiles – 2004

6. Workflow Definition • Focus Is On Processes • Tasks • Procedural Steps • Organizations Or People • Data: Required Input And Output Information • Tools

7. Benefits What’s in it for Me? • Clinical Users • Greater access to consistent information • Fewer errors, fewer tedious tasks • Buyers • Specify/purchase integration capabilities easily • Freedom to acquire “Best of Breed” systems • IT Professionals • Faster, more predictable integration projects • Facilitate cooperation of competing vendors • Administrators • Increased throughput • Better scheduling and tracking

8. www.rsna.org/ihe What is backing IHE ? IHE Technical Framework • Organized in sections that provide an increasing level of detail • Integration Profiles: Establish broad categories of compatible function. • Actors: Identify specific kinds of operational participants in the healthcare enterprise. • Transactions: Describe particular interactions between actors to perform specific operations.

9. Picking IHE Profiles ? Considerations • Potential Efficiency Gains • Cost-Effectiveness • Vendor Readiness • End-User Pain • Clinical Priorities • Available Resources / Skillsets • Improvements in Department Performance • Administrative Guidelines / Vision

10. What works well now? What does not work well now? What is a "relic from the past"? Search for redundancies Search for important, missing data Simplify the complex Still need all that paper? Shorten the start-to-finish cycle time Expect innovation Workflow Reengineering Analysis Questions IHE Answers • Defines one actor that controls every major piece of shared data • Remove ambiguities from standards • Improves access to information • Ensures synchronizing data in multiple systems • Mechanisms for correcting incorrect data • Eliminates “Vendor Lock-in” associated with proprietary data flows. • Keep healthy competition on applications ease of use.

11. Leveraging IHE in your RIS/PACS projects Classic Project Lifecyclewith IHE Added Value • Definition of Client Requirements – Site Analysis, Operational Workflow IHE Contribution – Use Cases ((Technical Framework Vol I) • Generation of Proposal - Review and Modify as Needed IHE Integration Statements Integration Profiles and Actors.Review vendors capabilities (Connectathon results) • Solution Development and Implementation Leverage Use Case Section in each Profile • Testing, QA and More Testing Connectathon Profile/Transaction Based-Testing SCAR Paper – QA and Acceptance Testing of PACS Project • Go-Live and Signoff Succeed with less Surprises • Post Implementation Review Evaluate benefits and ……. Submit your IHE User Success Story

12. IHE-Based Solution Development Start building the integrated healthcare enterprise

13. Where to start... • First, recognize what systems you need to integrate • See what Actors they implement and what Profiles they support • Ensure you have the Actors based on the Profiles you want to implement • By leveraging IHE, the first part can be done easily Note: You still have to include additional integration needs not covered by IHE.

14. report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted Scheduled Workflow Profile

15. Example: RIS to Modality Connection Order Filler RIS modality PerformedProcedure Step (PPS) AcquisitionModality Requires the Scheduled Workflow ProfileTwo Actors and two Transactions: Modality Worklist and PPS

16. DICOM: MWL Capable PPS Capable DICOM: MWL Capable PPS Capable Order Filler RIS AcquisitionModality Understand Capabilities of Actors modality PerformedProcedure Step (PPS) The Classical way:Try, issues ?Read the DICOM CSsTry again. The IHE way:1-Get the vendors to commit to the support of the same IHE Integration profile: Scheduled Workflow.2-Confirm with their IHE Integration Statements:Claim the right actors for the desired Integration Profile ?

17. Look at what was used from the IHE Technical Framework • TRIGGER EVENTSThe patient arrives at the Acquisition Modality for a procedure. • MESSAGE SEMANTICSThe Acquisition Modality uses the C-FIND Request of the DICOM Modality Worklist SOP Class to query for the worklist from the DSS/Order Filler. The Acquisition Modality performs the SCU role, and the DSS/Order Filler the SCP role.

18. Dealing with Legacy • Understand that you may have to deal with non-compliant devices and systems • Make best effort to bring them “up-to-date” • Initial implementations may provide partial support • Incremental usage of IHE is fine • It’s DICOM and HL7 anyway • Follow IHE’s yellow brick road...

19. Communication Your Plans to the Vendor • Present IHE as integration priority to Vendors. A Business goal ! • Use as a checklist for dealing w/vendors • Ensure you specify Actors, Profiles etc, • Ask for Integration Statements in RFP • Ensure Project Manager and team are knowledgeable at implementing IHE

20. Putting the Pieces Together • IHE compliant products exist • Review Products IHE Integration Statements • IHE Booth has dedicated workstation • Website – www.rsna.org/ihe • Make sure the IHE Integration Statements are for the correct versions of the software • Check the vendors’ results of IHE Connectathon • Ask your vendors to commit to deliver operational IHE Integration Profiles

21. IHE Integration Statement Date 12 Oct 2002 Vendor Product Name Version Any Medical Systems Co. IntegrateRAD V2.3 This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors Implemented Options Implemented Scheduled Workflow Image Manager/Image Archive none Image Display none Image Creator Performed Procedure Step Order Filler PPS Exception Management Simple Image and Numeric Report Report Creator none Internet address for vendor’s IHE information:www.anymedicalsystemsco.com/ihe Links to Standards Conformance Statements for the Implementation HL7 www.anymedicalsystemsco.com/hl7 DICOM www.anymedicalsystemsco.com/dicom/integrateRAD.pdf Links to general information on IHE In North America: www.rsna.org/IHE In Europe: www.ihe-europe.org In Japan: www.jira-net.or.jp/ihe-j IHE Integration Statement Find them at: www.rsna.org/IHE/integration_statements

22. Additional Information www.himss.org www.rsna.org/ihe • Brochures and Reprints • IHE Integration Profiles Overview • IHE At-a-Glance • Reprints of IHE technical papers • IHE Technical Framework • The IHE FAQ; IHE Video • IHE Fundamentals, Purchasing Strategies, IHE Primer • List of Vendors Product IHE Integration Statements • Connectathon Results • HIMSS Monograph